greater occipital nerve block

7/25/2019 Greater Occipital Nerve Block

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GREATER

OCCIPITALNERVE

BLOCKS

Dr Mehran Rezvani pain fellowshipanesthesiologist & acupuncturist


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Greater Occipital Nerve Bloc !" #sing

$ranscranial Doppler #ltrasonograph"



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Pain Physician 2010; 13:395-400 IN 1533-3159

!Letters to the %itor'



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GREATER OCCIPITAL

NERVEBLOCKS



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$he ter( "cci#i$a% n&'(a%)ia was)rst use in 1*21* when Beruta "Lenti+o an Ra(os (ae reference to

an occipital neuralgic s"nro(e

$he techni,ue of "cci#i$a% n&(+&,%"c see(s to !e )rst escri!e !"."nica In 1953



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$he )(&a$&( "cci#i$a% nerve gets)!ers fro( the /"(sa%pri(ar"ra(us of the s&c"n/ c&(+ica% nerve

an to a lesser e-tent fro( the $hi(/c&(+ica% n&(+&

Th& %&ss&( "cci#i$a% n&(+& arises

fro( the +&n$(a%pri(ar" ra(i of thes&c"n/ an/ $hi(/ cervical nerves



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.ND.C/$.ONS

ia)n"sis of occipital neuralgia

ana)&&n$ of occipital neuralgia

0 $reat(ent of cancer pain in region

0 1eaache associate with (usculartension or

spas(

0 Cervigonenic heaache

0 /nesthesia of posterior part of the scalp



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CON$R/.ND.C/$.ONS

0 Local infections

0 Coagulopathies

0 Metastasis in region0 Signi)cant !ehavioral a!nor(alities



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Classic (etho



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2osition

2atient s&a$&/an the h&a/ &&/slightl" forwar

Or

patient can lie #("n&with the heahy#&(&&/ on a pillow



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lan(ars

34'$he occipital arter"

35' $he (astoi process

36' $he greater occipital protu!erance



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$he arter" is palpate an a short 347485 7inch'*

597gauge neele is inserte throughthe sin at the level of the superiornuchal line

$he nerve is often (eial to the arter"at this level



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$he neele is avance until aparesthesia or !one is encounterean then withrawn 5 mm (WALDMAN : Theneedle is then redirected superiorly )

Local anesthetic solution of 579 (l isin+ecte after negative aspiration



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/ paresthesia is not necessar" for asuccessful !loc

.f $h& a($&(y is n"$ i/&n$i6&/* the(eication is in+ecte in a 7an-%i&7ashi"n3(eiall" an laterall"' an9 (l of local anesthetic is in+ecte



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$he %&ss&( "cci#i$a% n&(+& is !loce!" introucing the neele &/ia% $"$h& "(i)in "7 $h&

s$&(n"c%&i/"as$"i/ (uscle at the(astoi process



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:LDM/N;

lesser occipital nerve an a nu(!er ofsuper)cial !ranches of the greateroccipital nerve are then !loce !"irecting the neele laterall" anslightl" inferiorl"



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$o prolong e


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Neurol"tic Bloc

Neele is avance until a

paresthesia is encountere

.t will !e !etter to see for paresthesiawith a

s$i'%a$"( 8h&n $h& #a(&s$h&siais &$ 1 % #h&n"% ingl"cerine or O(nipa,ue is slowl"in+ecte after negative

as irationDr Mehran Rezvani pain fellowshipanesthesiologist & acupuncturist


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2ulse Raiofre,uenc"

/ 5-craiofre,uenc" n&&/%&with 5- ac$i+& tip

&ns"(ia% s$i'%a$i"n with afre,uenc" of 50 09(v



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/fter feeling the paresthesia* 4 (l of

2 %i/"cain& is in+ecte

T&n in'$&s %a$&(* pulse R? at @5AC

for two or three c"cles of 45>secons is perfor(e



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COM2L.C/$.ONS

Ecchy"sis "( h&a$"afor(ation can

occur

In$(a+asc'%a( in>&c$i"n of the localanesthetic can occur3ver" rare !utlea to CNS to-icit"'



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N&(+& in>'(y ue to the irecttrau(a fro(

the n&&/%& "( c"#(&ssi"n "7n&(+&s with large

volu(e of local anesthetic can occur

Neele in to the 7"(a&n a)n'can occur

3spinal !loc an respirator"e ression



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?ai%'(& $" ",$ain s'cc&ss7'% !loccan !e ue to an ana$"ic +a(ia$i"n

$he (ost co((on reason that greateran lesser ONB 7ai%s $" (&%i&+&heaache pain is

that the heaache s"nro(e !eingtreate has !een is/ia)n"s&/ as"cci#i$a% n&'(a%)ia



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$ranscranial

Doppler#ltrasonograph"



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Greater occipital arter"* which servesas the (ost relia!le lan(ar* ispalpate at this point

$CD ultrasonograph" can !e use toeasil" an precisel" etect pulsation

of the greater occipital arter"



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$he patient was place in the #("n"si$i"n* an $h& *-


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/fter the pulsating vessel wasienti)e* a 597

gauge 4097inch neele was inserte

+ust (eial to the point of pulsation*an a local anesthetic was in+ectearoun the arter"



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.t is necessar" to successfull" !locthe targete

region of the GON with ini'a"'n$ "7 %"ca% an&s$h&$ic for as#&ci6c /ia)n"sis

:1



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Ra+;

.f a iagnostic !loc is planne* theose shoul !e li(ite to 475 (l to

(ini(ize confusion

with relief of ("ofascial pain whenlarger volu(es are in+ecte



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T

greater occipital nerve block

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